Just to add to that as well, you didn't show Ortho Tricylen Lo- but you did show Ortho Tryclen. My doctor did suggest that as an alternative- he doesn't prescribe any of the diane 35 or yaz due to increase in blood clots. I also asked for testing of hormones and he said the blood work can't show you exact numbers- they only tell your if your hormones are normal or not. I just want some answers as to why this stuff is happening Do you think Ortho Tryclen Lo would be a better choice over the Alesse/Seasonale?

On 12/10/2013 at 12:20 AM, smichelle said:

Just to add to that as well, you didn't show Ortho Tricylen Lo- but you did show Ortho Tryclen. My doctor did suggest that as an alternative- he doesn't prescribe any of the diane 35 or yaz due to increase in blood clots. I also asked for testing of hormones and he said the blood work can't show you exact numbers- they only tell your if your hormones are normal or not. I just want some answers as to why this stuff is happening [Edited image out]Do you think Ortho Tryclen Lo would be a better choice over the Alesse/Seasonale?

I don't recommend most "Lo" pills because the ratio of progesterone/estrogen isn't right for acne.

I actually prefer Ortho Cyclen over Ortho Tri Cyclen, becaues Ortho Cyclen doesn't fluctuate. Can you ask him for Ortho Cyclen?

Oh really? Even though I don't really have inflamed acne at all- I'm relatively clear except the clogged areas..you'd still recommend the Ortho Cyclen instead of the LO? Maybe thats why there are so many horror stories for the Ortho Lo! Whats the difference between all of these? SO confusing

 

Just to add to that as well, you didn't show Ortho Tricylen Lo- but you did show Ortho Tryclen. My doctor did suggest that as an alternative- he doesn't prescribe any of the diane 35 or yaz due to increase in blood clots. I also asked for testing of hormones and he said the blood work can't show you exact numbers- they only tell your if your hormones are normal or not. I just want some answers as to why this stuff is happening Do you think Ortho Tryclen Lo would be a better choice over the Alesse/Seasonale?

I don't recommend most "Lo" pills because the ratio of progesterone/estrogen isn't right for acne.

I actually prefer Ortho Cyclen over Ortho Tri Cyclen, becaues Ortho Cyclen doesn't fluctuate. Can you ask him for Ortho Cyclen?

Sorry just adding to the above post- I'm so curious as to why I dont get " hormonal" acne- like everyone else gets when their birth controls are wrong. Those big painful cysts on their jaw/chin. I get oily skin and those little clogged bumps!! It makes no sense

On 12/10/2013 at 4:29 AM, smichelle said:

Oh really? Even though I don't really have inflamed acne at all- I'm relatively clear except the clogged areas..you'd still recommend the Ortho Cyclen instead of the LO? Maybe thats why there are so many horror stories for the Ortho Lo! Whats the difference between all of these? SO confusing [Edited image out]

On 12/10/2013 at 4:08 AM, Green Gables said:

On 12/10/2013 at 12:20 AM, smichelle said:

Just to add to that as well, you didn't show Ortho Tricylen Lo- but you did show Ortho Tryclen. My doctor did suggest that as an alternative- he doesn't prescribe any of the diane 35 or yaz due to increase in blood clots. I also asked for testing of hormones and he said the blood work can't show you exact numbers- they only tell your if your hormones are normal or not. I just want some answers as to why this stuff is happening [Edited image out] Do you think Ortho Tryclen Lo would be a better choice over the Alesse/Seasonale?

I don't recommend most "Lo" pills because the ratio of progesterone/estrogen isn't right for acne.

I actually prefer Ortho Cyclen over Ortho Tri Cyclen, becaues Ortho Cyclen doesn't fluctuate. Can you ask him for Ortho Cyclen?

Sorry just adding to the above post- I'm so curious as to why I dont get " hormonal" acne- like everyone else gets when their birth controls are wrong. Those big painful cysts on their jaw/chin. I get oily skin and those little clogged bumps!! It makes no sense

It just means you're a little luckier than most. Your sebum probably isn't as viscous, so it doesn't get thick enough to start creating a cyst down deep. Androgens increase sebum viscosity, and if you already genetically have thick sebum (like me) you will get cysts. If you have pretty thin sebum naturally, the androgens will only thicken it a little bit. So it gets near the surface and just barely clogs the pore.

Most "Lo" pills have more progesterone and less estrogen. The only thing that is "Lo" about it is the estrogen. For MOST women, the estrogen in birth control pills is VERY beneficial for the skin. Estrogen increases skin's suppleness, hydration, thins the sebum, and counteracts androgens.

"Lo" pills are really designed to give you the bare minimum of hormones necessary to prevent pregnancy. They are not really designed to help skin problems.

On 12/10/2013 at 7:41 AM, Green Gables said:

On 12/10/2013 at 4:29 AM, smichelle said:

Oh really? Even though I don't really have inflamed acne at all- I'm relatively clear except the clogged areas..you'd still recommend the Ortho Cyclen instead of the LO? Maybe thats why there are so many horror stories for the Ortho Lo! Whats the difference between all of these? SO confusing [Edited image out]

On 12/10/2013 at 4:08 AM, Green Gables said:

On 12/10/2013 at 12:20 AM, smichelle said:

Just to add to that as well, you didn't show Ortho Tricylen Lo- but you did show Ortho Tryclen. My doctor did suggest that as an alternative- he doesn't prescribe any of the diane 35 or yaz due to increase in blood clots. I also asked for testing of hormones and he said the blood work can't show you exact numbers- they only tell your if your hormones are normal or not. I just want some answers as to why this stuff is happening [Edited image out] Do you think Ortho Tryclen Lo would be a better choice over the Alesse/Seasonale?

I don't recommend most "Lo" pills because the ratio of progesterone/estrogen isn't right for acne.

I actually prefer Ortho Cyclen over Ortho Tri Cyclen, becaues Ortho Cyclen doesn't fluctuate. Can you ask him for Ortho Cyclen?

Sorry just adding to the above post- I'm so curious as to why I dont get " hormonal" acne- like everyone else gets when their birth controls are wrong. Those big painful cysts on their jaw/chin. I get oily skin and those little clogged bumps!! It makes no sense

It just means you're a little luckier than most. Your sebum probably isn't as viscous, so it doesn't get thick enough to start creating a cyst down deep. Androgens increase sebum viscosity, and if you already genetically have thick sebum (like me) you will get cysts. If you have pretty thin sebum naturally, the androgens will only thicken it a little bit. So it gets near the surface and just barely clogs the pore.

Most "Lo" pills have more progesterone and less estrogen. The only thing that is "Lo" about it is the estrogen. For MOST women, the estrogen in birth control pills is VERY beneficial for the skin. Estrogen increases skin's suppleness, hydration, thins the sebum, and counteracts androgens.

"Lo" pills are really designed to give you the bare minimum of hormones necessary to prevent pregnancy. They are not really designed to help skin problems.

Okay that makes sense. So I'd still be better off going on the Ortho Cyclen instead of the Lo? My dad had skin issues, and my brother does as well, meaning it definitely does run in my family. My brother had severe inflamed acne- and the only thing that worked was accutane. I never ever wanted to start that- so I always kept such a strict skin regimen, which maybe is why they never turn into full blown pimples but just closed comedones. It's making sense to me now that I always had these issues- just not as bad with Alesse as Seasonale, and why they got so much worse about 3 months into the Seasonale. Just one more question- being on Seasonale for almost a year, and Alesse for the last 2 weeks when my doctor suggested switching back- will starting ortho cyclen on sunday after my period is done be okay for my system?

 

1. Type of Progestin

Every birth control uses progestin (a synthetic form of the progesterone hormone). There are many different types of progestin. It is very important that the type of progestin is LOW in androgenic activity, meaning it doesn't send your testosterone into overdrive and create acne.

Here is a list to help choose a birth control.

Neutral (won't affect acne either way)

No hormones. Copper Paraguard IUD

 

Good (can reduce acne)

Drospirenone. Anti-androgenic. Used in Yaz, Yasmin, BeYa, Gianvi, Loryna, Ocella, Zarah

Norgestimate. Low androgenic. Ortho Tri Cyclen, Tri Sprintec, TriNessa, Ortho Cyclen, MonoNessa, Sprintec.

Cyproterone acetate. Low androgenic. Diane-35, Dianette.

Chlormadinone. Low-medium androgenic. Belara.

 

Not-so-good (may not make it worse, but probably won't make it better)

Ethynodial diacetate. Medium androgenic. Zovia, Demulen.

Desogestrel. Medium androgenic. Mircette, Apri, Reclipsen, Desogen, Kariva.

Gestodene. Medium androgenic, Femodene, Femodette, Millinette.

Norethindrone. Medium androgenic. Estrostep, Ortho Novum, Loestrin, Minestrin, Brevicon, Synphasic, Ovcon, Cyclafem.

 

Bad (pizza face alert!)

Levonorgestrel. High androgenic. Enpress, Plan B, Mirena IUD, Seasonique, Lutera, Portia, Amethyst, Alesse, Seasonale, Triquilar, Triphasil, Aviane.

Nogestrel. High androgenic. Cryselle, Ovral, Ogestrel, Ovrette.

Etonogestrel. Medium-high androgenic. NuvaRing, Implanon, Nexplanon.

DMPA. Medium-high androgenic. DepoProvera.

2. Level of Estrogen

Most birth control pills add in estradiol, which is a synthetic form of the hormone estrogen. Generally, skin is clearer when a pill has a moderate to a high level of estrogen.

The new "low-dose" pills basically take an existing pill, and cut down the estrogen, so you have way more progestin circulating in proportion to estradiol. It still works for birth control, since you can prevent pregnancy with progestin alone. But cutting the estrogen is bad news for acne most of the time.

This isn't a comprehensive list, but some common low-dose BC you should avoid:

No Estradiol, all Progestin

Depo Provera

Implanon

NuvaRing

Mini-pill

Mirena IUD

Nexplanon

Ultra Low-Dose

Alesse (Aviane, Lessina, Lutera, Sronyx)

Levlite

Loestrin Fe

Mircette

Ortho Tri Cyclen Lo

Low Dose

Cyclessa

Desogen

Levlen21

LoOvral

Microgestin Fe

Nordette

Orthocept

Seasonale (Seasonique)

3. Hormone Stability

For many, the right progestin type and the right estradiol level will clear them up just fine. For others, however, an extra step is needed. Some acne sufferers have breakouts every time their hormones fluctuate, such as at ovulation (when testosterone rises), or leading up to menstruation (when progesterone rises). Many pills, since their primary purpose is to prevent pregnancy as invisibly as possible, try to replicate normal hormone fluctuations. So each pill has a slightly different set of hormones, to put your body in a cycle. Some people just cannot get clear with their hormones changing all the time. If this sounds like you, please consider trying a "monophasic" pill, which keeps your hormone levels at an even keel throughout the month.

Monophasic Pills (NOT a comprehensive list, same colors from Progestin Type List)

Alesse

Brevicon

Diane-35 (Dianette)

Kariva

Ortho Cyclen (MonoNessa, Sprintec)

Yasmin

Yaz

Demulen (Zovia)

Make it easy for me, what do you recommend?

For some of you, this is just way too much information. However, don't just go to your dermatologist and tell him/her you want birth control. Many dermatologists, however educated they are, don't make very informed choices about hormonal acne. They'll just give you whatever brand is giving them free samples that month, or else their knowledge of hormonal acne is 10+ years old (concurrent with when they graduated medical school).

So, if you just want an easy answer, this my Top 6 list.

1. Yasmin (or Ocella or Zarah)

best type of progestin, monophasic, 30ug of estradiol

2. Yaz (or BeYaz)

best type of progestin, monophasic, but only 20ug of estradiol

3. Ortho Cyclen (or MonoNessa or Sprintec)

good progestin, monophasic, 35ug of estradiol

4. Diane-35 (or Dianette)

good progestin, monophasic, 35ug of estradiol

5. Demulen 1/35E or Demulen 1/50E (or Zovia 1/35E or Zovia 1/50E)

okay progestin, monophasic, 35ug or 50ug of estradiol

6. Ortho Novum 1/35 or Ortho Novum 1/50

okay progestin, monophasic, 35ug or 50ug of estradiol

Frequently Asked Questions

What about the mini-pill?

There are several different brand names for the mini-pill. A mini-pill uses only progestin and has no estrogen at all. Mini-pills are a terrible choice if you have acne, as they frequently cause acne in people who never had it in the first place. Some of the implant types of birth control, such as the Mirena IUD, also only use progestin, and can increase acne.

But my friend is on ______ and her skin is great! Even though it's on your bad list!

Look, I am just here to provide information and some general principles. There are always exceptions, and new information is coming out all the time. Feel free to ask questions, but in the end, you're gonna do what you want...if it doesn't work out in the end, well I won't say I told you so.

 

1. Type of Progestin

Every birth control uses progestin (a synthetic form of the progesterone hormone). There are many different types of progestin. It is very important that the type of progestin is LOW in androgenic activity, meaning it doesn't send your testosterone into overdrive and create acne.

Here is a list to help choose a birth control.

Neutral (won't affect acne either way)

No hormones. Copper Paraguard IUD

 

Good (can reduce acne)

Drospirenone. Anti-androgenic. Used in Yaz, Yasmin, BeYa, Gianvi, Loryna, Ocella, Zarah

Norgestimate. Low androgenic. Ortho Tri Cyclen, Tri Sprintec, TriNessa, Ortho Cyclen, MonoNessa, Sprintec.

Cyproterone acetate. Low androgenic. Diane-35, Dianette.

Chlormadinone. Low-medium androgenic. Belara.

 

Not-so-good (may not make it worse, but probably won't make it better)

Ethynodial diacetate. Medium androgenic. Zovia, Demulen.

Desogestrel. Medium androgenic. Mircette, Apri, Reclipsen, Desogen, Kariva.

Gestodene. Medium androgenic, Femodene, Femodette, Millinette.

Norethindrone. Medium androgenic. Estrostep, Ortho Novum, Loestrin, Minestrin, Brevicon, Synphasic, Ovcon, Cyclafem.

 

Bad (pizza face alert!)

Levonorgestrel. High androgenic. Enpress, Plan B, Mirena IUD, Seasonique, Lutera, Portia, Amethyst, Alesse, Seasonale, Triquilar, Triphasil, Aviane.

Nogestrel. High androgenic. Cryselle, Ovral, Ogestrel, Ovrette.

Etonogestrel. Medium-high androgenic. NuvaRing, Implanon, Nexplanon.

DMPA. Medium-high androgenic. DepoProvera.

2. Level of Estrogen

Most birth control pills add in estradiol, which is a synthetic form of the hormone estrogen. Generally, skin is clearer when a pill has a moderate to a high level of estrogen.

The new "low-dose" pills basically take an existing pill, and cut down the estrogen, so you have way more progestin circulating in proportion to estradiol. It still works for birth control, since you can prevent pregnancy with progestin alone. But cutting the estrogen is bad news for acne most of the time.

This isn't a comprehensive list, but some common low-dose BC you should avoid:

No Estradiol, all Progestin

Depo Provera

Implanon

NuvaRing

Mini-pill

Mirena IUD

Nexplanon

Ultra Low-Dose

Alesse (Aviane, Lessina, Lutera, Sronyx)

Levlite

Loestrin Fe

Mircette

Ortho Tri Cyclen Lo

Low Dose

Cyclessa

Desogen

Levlen21

LoOvral

Microgestin Fe

Nordette

Orthocept

Seasonale (Seasonique)

3. Hormone Stability

For many, the right progestin type and the right estradiol level will clear them up just fine. For others, however, an extra step is needed. Some acne sufferers have breakouts every time their hormones fluctuate, such as at ovulation (when testosterone rises), or leading up to menstruation (when progesterone rises). Many pills, since their primary purpose is to prevent pregnancy as invisibly as possible, try to replicate normal hormone fluctuations. So each pill has a slightly different set of hormones, to put your body in a cycle. Some people just cannot get clear with their hormones changing all the time. If this sounds like you, please consider trying a "monophasic" pill, which keeps your hormone levels at an even keel throughout the month.

Monophasic Pills (NOT a comprehensive list, same colors from Progestin Type List)

Alesse

Brevicon

Diane-35 (Dianette)

Kariva

Ortho Cyclen (MonoNessa, Sprintec)

Yasmin

Yaz

Demulen (Zovia)

Make it easy for me, what do you recommend?

For some of you, this is just way too much information. However, don't just go to your dermatologist and tell him/her you want birth control. Many dermatologists, however educated they are, don't make very informed choices about hormonal acne. They'll just give you whatever brand is giving them free samples that month, or else their knowledge of hormonal acne is 10+ years old (concurrent with when they graduated medical school).

So, if you just want an easy answer, this my Top 6 list.

1. Yasmin (or Ocella or Zarah)

best type of progestin, monophasic, 30ug of estradiol

2. Yaz (or BeYaz)

best type of progestin, monophasic, but only 20ug of estradiol

3. Ortho Cyclen (or MonoNessa or Sprintec)

good progestin, monophasic, 35ug of estradiol

4. Diane-35 (or Dianette)

good progestin, monophasic, 35ug of estradiol

5. Demulen 1/35E or Demulen 1/50E (or Zovia 1/35E or Zovia 1/50E)

okay progestin, monophasic, 35ug or 50ug of estradiol

6. Ortho Novum 1/35 or Ortho Novum 1/50

okay progestin, monophasic, 35ug or 50ug of estradiol

Frequently Asked Questions

What about the mini-pill?

There are several different brand names for the mini-pill. A mini-pill uses only progestin and has no estrogen at all. Mini-pills are a terrible choice if you have acne, as they frequently cause acne in people who never had it in the first place. Some of the implant types of birth control, such as the Mirena IUD, also only use progestin, and can increase acne.

But my friend is on ______ and her skin is great! Even though it's on your bad list!

Look, I am just here to provide information and some general principles. There are always exceptions, and new information is coming out all the time. Feel free to ask questions, but in the end, you're gonna do what you want...if it doesn't work out in the end, well I won't say I told you so.

Hi Green Gables,

I have a question for you as tonight is the night I'm going to be starting the Ortho Cyclen! I'm doing some research on which hormone relates to overly oily skin and clogging- and I keep coming across Estrogen dominance. How people with too much bad estrogen will see in increase in sebum and therefore skin issues. Is it possible at all that the increase in estrogen from the Alesse(0.2) and Seasonale(0.3) is what's causing my issues? Or is this even possible because they are both considered " Low estrogen pills". I'm trying to figure out if it's that or the progestrin with high androgen levels in both those birth controls that is causing the issues? Please share your knowledge on how hormones work and which one it's most likely to be So confused, and I don't want my skin getting even worse with Ortho Cyclen being (0.4) in estrogen if that's what it is! Help!!

I will make certain people on this board upset by saying this, but there is not a lot of evidence that shows that estrogen causes acne. Too much estrogen can cause weight gain and some other side effects. But in general, estrogen does wonderful things for the skin, such as counteracting androgens, increasing the skin's ability to stay hydrated and supple, and decreasing sebum viscosity. The baby soft, poreless skin we associate with women is because of the estrogen. The grizzled, coarse skin we associate with men is because of their higher androgen levels.

You really need to give a good anti-androgen protocol (such as using Ortho Cyclen) a chance before worrying about "estrogen dominance." For most women, countering the androgens is what ultimately solves the acne.

I know you're in a difficult place right now, but you're only going to halt your progress by trying to research every possible avenue. Get the Ortho Cyclen. Give it a few months. Don't focus on the acne for a bit. In a few months, come back and re-assess where you're at.

When I started spironolactone, I tried to just ignore the acne, take my pill, and live my life. I didn't even visit these boards much. I think if I had obsessed about my "progress" or "is this really the right course of action", I would have given up on spiro and not be enjoying clear skin right now.

Don't ever(ever!) use Aviane.

Oh my god, my face was exploding and I was on it for like two months: cysts, white heads, multiple cysts in one area, you name it, I had it, I looked like I was deformed it was so bad!. Just...no. I hate my doctor far putting me on that one.

I really wanted to try Yasmin but my mom freaked out because it has a slightly higher risk for blood clots, maybe one day! [Edited image out]

On 12/16/2013 at 6:32 PM, AgentEmily said:

Don't ever(ever!) use Aviane.

Oh my god, my face was exploding and I was on it for like two months: cysts, white heads, multiple cysts in one area, you name it, I had it, I looked like I was deformed it was so bad!. Just...no. I hate my doctor far putting me on that one.

I really wanted to try Yasmin but my mom freaked out because it has a slightly higher risk for blood clots, maybe one day! [Edited image out]

Every single birth control pill has a risk of blood clots. That is just what happens when you put synthetic hormones in your body. Yasmin/Yaz is one of the MOST popular birth controls worldwide. There are more reported blood clot issues with Yasmin because so many people use it, so naturally when more people overall are using it, there are going to be more people who report issues. But there are also far more people who have had great success with Yasmin than any other birth control as well. But you don't hear about those, because happy people don't complain

It's good to be safe, but if you're going to get blood clots on Yasmin, you're probably going to get it on any birth control.

I have been taking Velivet, the generic version of Cyclessa, for three straight months and I have noticed an immense difference in my acne. I used to get painful, huge, and clusters of acne on my cheeks and since taking this birth control, it has greatly reduced my acne. It's not as effective as I would like it to be but maybe in time my acne will be less and less. The only thing that sucks is all of the hyperpigmention I have from my acne!

Hi Green Gables,
Thanks for such an informative post! I have been suffering from severe acne for a long time and was once on accutane and my acne cleared up for about three years. This past year ive been on sprintec (which my doctor said was the generic version of ortho cyclen and you recommended) and have seen a reduction on my cystic acne but alas, i still have whiteheads that pop up frequently around my jawline and mouth. I've been thinking about making the switch to ortho tri cyclen because I read it is one of the few oral contraceptives approved by the FDA for acne. Like I previously stated, I know you recommend people to try ortho cyclen of the stability of amount of hormones. Would this be a good switch?

Hi Green Gables,

Thanks for such an informative post! I have been suffering from severe acne for a long time and was once on accutane and my acne cleared up for about three years. This past year ive been on sprintec (which my doctor said was the generic version of ortho cyclen and you recommended) and have seen a reduction on my cystic acne but alas, i still have whiteheads that pop up frequently around my jawline and mouth. I've been thinking about making the switch to ortho tri cyclen because I read it is one of the few oral contraceptives approved by the FDA for acne. Like I previously stated, I know you recommend people to try ortho cyclen of the stability of amount of hormones. Would this be a good switch?

In my opinion, Ortho Cyclen is better for acne overall than Ortho Tri Cyclen.

The FDA recommends Ortho Tri Cyclen for acne because it was one of the first to ever be used/studied for acne and show some improvement. That doesn't mean a whole lot in context.

If you've been on Ortho Cyclen for a whole year and don't feel that it has reduced your acne enough, it may be time to switch to Yasmin, Yaz, or Diane-35.

Should note though...

If the main problem is whiteheads and not cysts anymore, sometimes this is linked to irritation from toothpaste/mouthwash products. You can ask your dermatologist about "perioral dermatitis". However most derms just give you an antibiotic for this. I found this didn't help in the long run. What worked for me was using fluoride-free and sulfate-free tooth care products.

GreenGables,

Since spiro seems to no longer be working for me, would you suggest Yaz or Yasmin or will they probably not work if I've become resistant to the anti-androgen ingredient in spiro? Or will they better balance the estrogen while lowering testosterone and be more effective?

not sure why you ranked Yaz as better than Diane 35, in my experience Yaz has been moderately effective, while Diane 35 just completely blew me away. I didn't know my skin could possibly look that amazing when I'd first tried it.

GreenGables,

Since spiro seems to no longer be working for me, would you suggest Yaz or Yasmin or will they probably not work if I've become resistant to the anti-androgen ingredient in spiro? Or will they better balance the estrogen while lowering testosterone and be more effective?

Spironolactone is no longer working for you??! How long have you been on it? Your freakin me out now.

Three years. But I've heard of it working on people for ten years, so don't freak out.

Three years. But I've heard of it working on people for ten years, so don't freak out.

Wow. What does your Derm say? I didn't think it would be something that would stop working. Is it possible to increase your dose?

He's completely unhelpful. He simply said "I suppose it's possible (to become resistant)". I tried increasing my dose and it did not help.

He's completely unhelpful. He simply said "I suppose it's possible (to become resistant)". I tried increasing my dose and it did not help.

Ugh what the hell! I'm so sorry.

It still baffles me how there are so many cures for other disease and we can send people into space....yet no 100% cure for acne.

I don't want to sound like a conspiracy theorist but I bet you there is a cure or they're close to a cure but corporations suppress it reaching market because billions would be lost in the business of addressing the symptoms (versus cause).

Thanks for the support and I definitely wish I had an answer about why spiro stopped working for me because I had perfect skin for years!

Anyone know of any drug or vitamin interactions that may reduce spiro's effectiveness?

I found this info really helpful, so thank you! I have a question though.....I am 36 and was on the pill for years. I also have monthly migraines. I have 2 children and am not having any more. I got an IUD (Mirena) 4 months ago. I was also on Spiro for my acne. Since getting off the pill my acne has blown up!!!! It's devastating! I am not getting any more migraines though, which is awesome. I just want to know if it is ok to take the pill and have an IUD at the same time? This would cure all my problems.......well, health stuff anyway. Ha ha!! Thanks!!!!!!

I don't want to sound like a conspiracy theorist but I bet you there is a cure or they're close to a cure but corporations suppress it reaching market because billions would be lost in the business of addressing the symptoms (versus cause).

Thanks for the support and I definitely wish I had an answer about why spiro stopped working for me because I had perfect skin for years!

Anyone know of any drug or vitamin interactions that may reduce spiro's effectiveness?

I've thought about that too. How horrible would that be if there was a cure and "they" are keeping it from the world.

You can find a list of drug interactions by googling it. It will show light, to moderate, to high drugs that interfere with spironolactone

Green Gables,

Do some birth controls help or reduce oily skin at all? I was on Alesse/Seasonale before this which is known for it's worsening of acne and I know that alot of birth controls make acne and therefore oily skin even worse..But its been a full month on Ortho Cyclen- which has low androgenic effects and I still have veryyy oily skin and clogged pores. Does this ever change?! Or will I have to stop BC completely for the oily skin to reduce?

Please any advice!!!

 

1. Type of Progestin

Every birth control uses progestin (a synthetic form of the progesterone hormone). There are many different types of progestin. It is very important that the type of progestin is LOW in androgenic activity, meaning it doesn't send your testosterone into overdrive and create acne.

Here is a list to help choose a birth control.

Neutral (won't affect acne either way)
No hormones. Copper Paraguard IUD

Good (can reduce acne)
Drospirenone. Anti-androgenic. Used in Yaz, Yasmin, BeYa, Gianvi, Loryna, Ocella, Zarah
Norgestimate. Low androgenic. Ortho Tri Cyclen, Tri Sprintec, TriNessa, Ortho Cyclen, MonoNessa, Sprintec.
Cyproterone acetate. Low androgenic. Diane-35, Dianette.

Chlormadinone. Low-medium androgenic. Belara.

Not-so-good (may not make it worse, but probably won't make it better)
Ethynodial diacetate. Medium androgenic. Zovia, Demulen.
Desogestrel. Medium androgenic. Mircette, Apri, Reclipsen, Desogen, Kariva.
Gestodene. Medium androgenic, Femodene, Femodette, Millinette.
Norethindrone. Medium androgenic. Estrostep, Ortho Novum, Loestrin, Minestrin, Brevicon, Synphasic, Ovcon, Cyclafem.

Bad (pizza face alert!)
Levonorgestrel. High androgenic. Enpress, Plan B, Mirena IUD, Seasonique, Lutera, Portia, Amethyst, Alesse, Seasonale, Triquilar, Triphasil, Aviane.
Nogestrel. High androgenic. Cryselle, Ovral, Ogestrel, Ovrette.
Etonogestrel. Medium-high androgenic. NuvaRing, Implanon, Nexplanon.
DMPA. Medium-high androgenic. DepoProvera.

2. Level of Estrogen

Most birth control pills add in estradiol, which is a synthetic form of the hormone estrogen. Generally, skin is clearer when a pill has a moderate to a high level of estrogen.

The new "low-dose" pills basically take an existing pill, and cut down the estrogen, so you have way more progestin circulating in proportion to estradiol. It still works for birth control, since you can prevent pregnancy with progestin alone. But cutting the estrogen is bad news for acne most of the time.

This isn't a comprehensive list, but some common low-dose BC you should avoid:

No Estradiol, all Progestin

Depo Provera

Implanon

NuvaRing

Mini-pill

Mirena IUD

Nexplanon

Ultra Low-Dose

Alesse (Aviane, Lessina, Lutera, Sronyx)

Levlite

Loestrin Fe

Mircette

Ortho Tri Cyclen Lo

Low Dose

Cyclessa

Desogen

Levlen21

LoOvral

Microgestin Fe

Nordette

Orthocept

Seasonale (Seasonique)

3. Hormone Stability

For many, the right progestin type and the right estradiol level will clear them up just fine. For others, however, an extra step is needed. Some acne sufferers have breakouts every time their hormones fluctuate, such as at ovulation (when testosterone rises), or leading up to menstruation (when progesterone rises). Many pills, since their primary purpose is to prevent pregnancy as invisibly as possible, try to replicate normal hormone fluctuations. So each pill has a slightly different set of hormones, to put your body in a cycle. Some people just cannot get clear with their hormones changing all the time. If this sounds like you, please consider trying a "monophasic" pill, which keeps your hormone levels at an even keel throughout the month.

Monophasic Pills (NOT a comprehensive list, same colors from Progestin Type List)

Alesse

Brevicon

Diane-35 (Dianette)

Kariva

Ortho Cyclen (MonoNessa, Sprintec)

Yasmin

Yaz

Demulen (Zovia)

Make it easy for me, what do you recommend?

For some of you, this is just way too much information. However, don't just go to your dermatologist and tell him/her you want birth control. Many dermatologists, however educated they are, don't make very informed choices about hormonal acne. They'll just give you whatever brand is giving them free samples that month, or else their knowledge of hormonal acne is 10+ years old (concurrent with when they graduated medical school).

So, if you just want an easy answer, this my Top 6 list.

1. Yasmin (or Ocella or Zarah)

best type of progestin, monophasic, 30ug of estradiol

2. Yaz (or BeYaz)

best type of progestin, monophasic, but only 20ug of estradiol

3. Ortho Cyclen (or MonoNessa or Sprintec)

good progestin, monophasic, 35ug of estradiol

4. Diane-35 (or Dianette)

good progestin, monophasic, 35ug of estradiol

5. Demulen 1/35E or Demulen 1/50E (or Zovia 1/35E or Zovia 1/50E)

okay progestin, monophasic, 35ug or 50ug of estradiol

6. Ortho Novum 1/35 or Ortho Novum 1/50

okay progestin, monophasic, 35ug or 50ug of estradiol

Frequently Asked Questions

What about the mini-pill?

There are several different brand names for the mini-pill. A mini-pill uses only progestin and has no estrogen at all. Mini-pills are a terrible choice if you have acne, as they frequently cause acne in people who never had it in the first place. Some of the implant types of birth control, such as the Mirena IUD, also only use progestin, and can increase acne.

But my friend is on ______ and her skin is great! Even though it's on your bad list!

Look, I am just here to provide information and some general principles. There are always exceptions, and new information is coming out all the time. Feel free to ask questions, but in the end, you're gonna do what you want...if it doesn't work out in the end, well I won't say I told you so.

Hi Green Gables!

Your post is awesome! Do you have any idea which would be an okay pill for acne and endometriosis? Based on the information I've read so far, the best pills for acne higher estrogen and lower androgen potency but the best ones for endometriosis have lower estroge, higher progestin potency and higher androgen potency. It looks like the complete opposite but I'm hoping you know of something that may work for both.

Thanks!

Hey there! I'm a follower of this thread and read your post. Green gables is not active on the site much anymore I don't believe. But I am happy to try and weigh in on your questions. I use Yasmin and also Spironolactone to control my hormonal acne. It can take 2-4 months for any hormonal treatment to start to have an effect on balancing out levels. Yasmin has been great for me and few side affects, it tends to make women very moody, which I can say the first time I took it this was the case, but I do believe it leveled out over time. Spironolactone is an androgen blocker that helps with higher testosterone or sensitivity to it. Yasmin and Diane have similar effects but at lower doses. I take 75mg Spiro in addition to Yasmin, it's been about 3 1/2 months and am starting to see results. There are many posts on here about both treatments for hormonal acne. I would definitely suggest looking into these methods before Accutane. Accutane has helped many people, however if you problem stems from a hormonal issue, it may return even after stopping accutane. Monophasic pills are helpful at maintaining levels throughout the month. However when you do take your inactive pills and have a withdrawal bleeding "period" your hormonal levels will change just as any pill. Over time this should stabilize. Hope this has provided some kind of insight!

So this post was very enlightening.

I've been on hbc for a while. Was on Alesse for ages, and I didn't really notice the whole acne thing - I'd always had it, was a teenager, as well as an athlete. Happens, ya know? It seemed fine, it wasn't super unmanageable but it made me sad. Then I had a whole bunch of other medical problems and wound up on lamotrigine. I don't know why but maybe this seemed to make my acne a bit worse. So my doctor suggested switching my birth control I went on (I think it was) Diane, but apparently estrogen cuts lamotrigine levels noticeably, so it was a disaster. I totally bailed on that front and decided Mirena would be way better for my brain and I could figure out my meds without too much interference, and in that sense Mirena was really awesome. But yeah definitely didn't do squat for my acne. It didn't actually get worse until a year in, though, and now I have bad body acne and acne on my jaw/near my ears. With retin-A and BP though my actual face is pretty clear, but my back and chest seem to be getting worse despite all kinds of topicals (I refuse antibiotics)

So now, before I try accutane or something, I'm thinking of going on Yaz, because it has the good kind of progestin, but the way lower estrogen levels than yasmin or diane, and it's monophasic so no hormone changes to mess with my meds (if my blood levels are lower at least it'll be consistent)...

How quickly do you think I would see a difference in my skin, and how fast does your body typically adjust to a big hormone change? Also does monophasic actually make your hormones almost exactly the same 30 days a month..? I'm going in to my doc on monday and I'd like to be well prepared/have made a difference.